Provider Demographics
NPI:1912037623
Name:RUTLEDGE, KAREN NOREEN (LMP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:NOREEN
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34606 SE FALL CITY SNOQUALMIE RD
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024
Mailing Address - Country:US
Mailing Address - Phone:425-222-0708
Mailing Address - Fax:425-313-0198
Practice Address - Street 1:1595 NW GILMAN BLVD
Practice Address - Street 2:#15
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-392-4387
Practice Address - Fax:425-313-0198
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist